Provider Demographics
NPI:1316943905
Name:KERKES, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:KERKES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4614 S KIRKMAN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2891
Mailing Address - Country:US
Mailing Address - Phone:407-512-5700
Mailing Address - Fax:800-752-1493
Practice Address - Street 1:4614 S KIRKMAN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2891
Practice Address - Country:US
Practice Address - Phone:407-512-5700
Practice Address - Fax:800-752-1493
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
593516436003OtherTRICARE
7194953OtherMAMSI
773114OtherMAILHANDLERS
593516436OtherMEDICAL MUTUAL
FL47696OtherBCBS
695956OtherTUFTS
P00397528OtherRR GBA MEDICARE
593516436003OtherTRICARE
7194953OtherMAMSI